THE SAMUEL GRIFFITH SOCIETY

Membership Application

Please print off the following form and post it to us with your cheque and we will respond to your application as soon as practicable.

I, .......................................................................................

of ......................................................................................

...........................................................................................

Occupation: ...................................................................

Phone: ..................................................                         Fax: ......................................................

E-mail: .................................................

desire to become a member of The Samuel Griffith Society.

In the event of my admission as a member, I agree to be bound by the rules of the Society for the time being in force.

 

Signature of Applicant:...........................................................................   Date:......................................


My cheque is enclosed for $ .......................          (Joining Fee plus Annual Sub)

(Joining Fee: $20; Annual Sub $75)

(Bona fide Students: Annual Sub $25---Joining Fee waived)


Please send the completed form with your cheque to:

The Samuel Griffith Society
17 Fitzsimmons Avenue
Lane Cove, NSW 2066


Return to Home Page